Provider Demographics
NPI:1134841901
Name:LITTLE DIPPER PHYSICAL THERAPY
Entity type:Organization
Organization Name:LITTLE DIPPER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGRO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:716-491-1179
Mailing Address - Street 1:4782 TONAWANDA CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-9534
Mailing Address - Country:US
Mailing Address - Phone:716-491-1179
Mailing Address - Fax:716-260-2003
Practice Address - Street 1:6535 CAMPBELL BLVD STE A
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9119
Practice Address - Country:US
Practice Address - Phone:716-491-1179
Practice Address - Fax:716-260-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy